Abstract: This thesis examines how prevailing notions of sex, gender, sexuality and transgender are resisted, challenged and expanded by the lived realities of trans men. Despite revisions to treatment guidelines and diagnostic descriptions, transgender medicine continues to be based on a paradigmatic narrative of ‘being born in the wrong body’. In so doing, trans medicine produces gender, sex and ‘gender dysphoria’ as static, predetermined and independent of medical encounters, replicating limited notions of gender and sexuality that hinge on gender/genital ‘alignment’. This thesis questions that familiar depiction. By examining trans men’s own accounts of embodiment and sexuality in autobiographical writing, I argue that the variety of ways trans men enact maleness, including sexually, is necessarily neglected in current clinical practices of trans medicine.

By mobilising analytic frameworks from science and technology studies (STS) that highlight how ontologies are made in practice and phenomena are better understood as multiple and emergent, rather than definite and independent, I explore how we can more usefully understand trans ontologies and practice trans medicine. Focussing on the situatedness of phenomena offers a more productive and nuanced way to think through the necessarily complex ways that trans people experience and enact sex, gender and sexual pleasures.

Divided into three parts, the first part of this study analyses medical epistemologies and clinical practices, including an autoethnographic account of my own experiences as a trans patient. Drawing on John Law’s analysis of common-sense realism in tandem with Karen Barad’s theory of agential realism, I argue that medicine flattens out the complexities of trans realities, and simultaneously reiterates a singular notion of what transgender (and gender) ‘is’. The second part of the thesis explores the autobiographical accounts of other trans men, demonstrating that there are a variety of ways trans men experience sex, gender and sexuality. Building on Annemarie Mol’s notion of ‘the body multiple’, I argue that trans men enact maleness via narrative strategies and sexual practices, as well as medical interventions. The third part of this thesis uses the findings of the first two parts to challenge the clinical practices of transgender medicine, in part by analysing the treatment pathways available to nontrans cosmetic surgery patients. In so doing, I also consider how we might intervene in order to broaden the field of trans possibilities.